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Traditional and non-traditional strategies to optimize catheter function: go with more flow

Michele H Mokrzycki1, Charmaine E Lok

  • 1Division of Nephrology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.

Kidney International
|October 1, 2010
PubMed

Insights

Central venous catheters (CVCs) are common for initiating hemodialysis (HD) but often malfunction, leading to poor patient outcomes. This review details CVC malfunction causes, prevention, and management strategies for long-term HD patients.

Area of Science:

  • Nephrology
  • Vascular Access
  • Renal Replacement Therapy

Background:

  • Over 340,000 US patients require hemodialysis (HD), often initiated with central venous catheters (CVCs).
  • While CVCs offer immediate access, they are linked to significant morbidity, mortality, and suboptimal patient care.
  • Despite efforts to reduce CVC use, some patients require long-term CVCs due to comorbidities or vessel exhaustion.

Purpose of the Study:

  • To review the etiology, prevention, and management of central venous catheter malfunction in hemodialysis patients.
  • To highlight the challenges and suboptimal outcomes associated with long-term CVC dependence.
  • To provide insights into improving care for patients reliant on CVCs for hemodialysis.

Main Methods:

  • Literature review focusing on central venous catheter (CVC) malfunction in hemodialysis (HD).
  • Analysis of causes, prevention strategies, and management of CVC-related issues.
  • Synthesis of current understanding regarding CVC performance and patient outcomes.

Main Results:

  • Central venous catheter malfunction ('poor flows') and infection are primary problems for long-term HD patients.
  • Catheter malfunction results in inadequate dialysis, costly interventions, and reduced quality of life.
  • Despite advantages, CVCs present significant disadvantages compared to other vascular access types.

Conclusions:

  • Central venous catheter use in hemodialysis, particularly long-term, is associated with significant complications.
  • Addressing CVC malfunction is crucial for improving patient outcomes and reducing healthcare costs.
  • Further research and clinical efforts are needed to minimize CVC-related issues in hemodialysis.

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